Effectiveness comparison between minimally invasive surgery and traditional open reduction internal fixation in treatment of unstable distal radial fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHONG Zeli , WU Chao , LIN Xu , HU Haigang

Department of Orthopaedics, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P.R.China;

Corresponding?author：

ZHONG Zeli, Email: zhongzeli@sina.cn

Keywords：

Distal radial fracture; minimally invasive; open reduction; locking plate; internal fixation

DOI：

10.7507/1002-1892.201711140

Video：

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ObjectiveTo compare the effectiveness of minimally invasive percutaneous internal fixation and traditional open reduction via Henry approach and internal fixation in the treatment of unstable distal radial fractures.MethodsFifty-six patients with unstable distal radial fractures that met the selection criteria between October 2013 and December 2014 were randomly divided into minimally invasive group (26 cases) and traditional group (30 cases). They were treated with oblique T-shaped locking plate internal fixation via minimally invasive percutaneous approach or traditional Henry approach. There was no significant difference in gender, age, side, causes of injury, fracture classification, and time from injury to operation between 2 groups (P>0.05). The length of incision, operation time, intraoperative blood loss, hospitalization time, and fracture healing time were recorded in 2 groups. The difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation were compared between 2 groups. The visual analogue scale (VAS) score, the percentage of the lateral wrist flexion and extension range, forearm rotation, and the hand grip strength (recorded as FS%, FR%, and HG% , respectively) were compared between 2 groups at 4 weeks and 3 months postoperatively. The wrist function was evaluated through the disability of arm-shoulder-hand (DASH) scores at 3 months postoperatively.ResultsThe length of incision, operation time, intraoperative blood loss, and hospitalization time in minimally invasive group were significantly less than those in traditional group (P<0.05). The incisions of 2 groups were all achieved primary healing. All patients were followed up 10-16 months (mean, 12.6 months). There was no radial artery injury, screw too long, or screw entering the joint space. In minimally invasive group, 1 patient had the symptoms of median nerve irritation after operation, and recovered completely at 1 month; in traditional group, there were 2 cases of tendon irritation after operation. There was no significant difference in the fracture healing time, the difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation between 2 groups (P>0.05). At 4 weeks after operation, the VAS score in minimally invasive group was significantly less than that in traditional group, and the FS%, FR%, and HG% were significantly higher than those in traditional group (P<0.05). There was no significant difference in above indicators between 2 groups at 3 months after operation (P>0.05). The DASH score in minimally invasive group was significantly less than that in traditional group at 3 months after operation (t=–5.308, P=0.000). The patient’s aesthetic evaluation of postoperative wound in minimally invasive group was better than in traditional group.ConclusionFor treatment of unstable distal radial fractures, the metacarpal minimally invasive internal fixation has the advantages of smaller wound, incisional concealment, and quicker recovery of wrist joint.

Citation： ZHONG Zeli, WU Chao, LIN Xu, HU Haigang. Effectiveness comparison between minimally invasive surgery and traditional open reduction internal fixation in treatment of unstable distal radial fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(3): 322-328. doi: 10.7507/1002-1892.201711140 Copy

1.	Hanel DP, Jones MD, Trumble TE. Wrist fractures. Orthop Clin North Am, 2002, 33(1): 35-57.
2.	貢小英, 榮國威, 安貴生, 等. 經掌側入路治療橈骨遠端不穩定骨折療效分析. 中華骨科雜志, 2005, 25(1): 50-53.
3.	Zenke Y, Sakai A, Oshige T, et al. Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis. J Orthop Trauma, 2011, 25(7): 425-431.
4.	王繼宏, 溫樹正, 樊東升, 等. 掌側入路角度鎖定接骨板與外固定支架治療橈骨遠端骨折的比較研究. 中華手外科雜志, 2015, 31(5): 353-356.
5.	王立, 邵新中, 張哲敏, 等. 腕關節鏡輔助下閉合復位外固定治療橈骨遠端骨折. 中華手外科雜志, 2014, 30(5): 324-326.
6.	韋旭明, 荊振中, 殷渠東, 等. 跨腕鋼板技術治療橈骨遠端粉碎性骨折的研究進展. 中華創傷骨科雜志, 2015, 17(1): 90-92.
7.	Rogachefsky RA, Lipson SR, Applegate B, et al. Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Joint Surg (Am), 2001, 83-A(4): 509-519.
8.	Lalone EA, Rajgopal V, Roth J, et al. A cohort study of one-year functional and radiographic outcomes following intra-articular distal radius fractures. Hand (N Y), 2014, 9(2): 237-243.
9.	Heidari N, Clement H, Kosuge D, et al. Is sparing the pronator quadratus muscle possible in volar plating of the distal radius? J Hand Surg (Eur Vol), 2012, 37(5): 402-406.
10.	Lee SK, Chaudhry S. Open reduction and internal fixation through fracture fragment specific fixation methods. Oper Tech Orthop, 2009, 19(2): 70-76.
11.	姜保國, 張殿英, 付中國, 等. 橈骨遠端骨折的治療建議. 中華創傷骨科雜志, 2010, 12(11): 1053-1056.
12.	Orbay JL, Touhami A, Orbay C. Fixed angle fixation of distal radius fractures through a minimally invasive approach. Tech Hand Up Extrem Surg, 2005, 9(3): 142-148.
13.	鄧芒, 傅中國, 張殿英, 等. 橈骨遠端骨折掌側與背側接骨板固定的生物力學比較. 中華手外科雜志, 2008, 24(4): 213-216.
14.	郭雅娣, 閔捷, 李峻, 等. 單一鎖定加壓鋼板掌側入路治療橈骨遠端骨折. 中華手外科雜志, 2014, 30(3): 235-236.
15.	Vosbikian MM, Ketonis C, Huang R, et al. Optimal positioning for Volar Plate Fixation of a distal radius fracture determining the distal dorsal cortical distance. Orthop Clin North Am, 2016, 47(1): 235-244.
16.	Imatani J, Noda T, Morito Y, et al. Minimally invasive plate osteosynthesis for comminuted fractures of the metaphysis of the radius. J Hand Surg (Br), 2005, 30(2): 220-225.
17.	Swigart CR, Badon MA, Bruegel VL, et al. Assessment of pronator quadratus repair integrity following volar plate fixation for distal radius fractures: a prospective clinical cohort study. J Hand Surg (Am), 2012, 37(9): 1868-1873.
18.	Hershman SH, Immerman I, Bechtel C, et al. The effects of pronator quadratus repair on outcomes after volar plating of distal radius fractures. J Orthop Trauma, 2013, 27(3): 130-133.
19.	樊健, 蔣波, 陳凱, 等. 比較不切開與切開旋前方肌對橈骨遠端骨折掌側鋼板內固定術后療效的影響. 中華創傷骨科雜志, 2015, 17(10): 902-904.
20.	Mccann PA, Amirfeyz R, Wakeley C, et al. The volar anatomy of the distal radius-an MRI study of the FCR approach. Injury, 2010, 41(10): 1012-1014.

1. Hanel DP, Jones MD, Trumble TE. Wrist fractures. Orthop Clin North Am, 2002, 33(1): 35-57.
2. 貢小英, 榮國威, 安貴生, 等. 經掌側入路治療橈骨遠端不穩定骨折療效分析. 中華骨科雜志, 2005, 25(1): 50-53.
3. Zenke Y, Sakai A, Oshige T, et al. Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis. J Orthop Trauma, 2011, 25(7): 425-431.
4. 王繼宏, 溫樹正, 樊東升, 等. 掌側入路角度鎖定接骨板與外固定支架治療橈骨遠端骨折的比較研究. 中華手外科雜志, 2015, 31(5): 353-356.
5. 王立, 邵新中, 張哲敏, 等. 腕關節鏡輔助下閉合復位外固定治療橈骨遠端骨折. 中華手外科雜志, 2014, 30(5): 324-326.
6. 韋旭明, 荊振中, 殷渠東, 等. 跨腕鋼板技術治療橈骨遠端粉碎性骨折的研究進展. 中華創傷骨科雜志, 2015, 17(1): 90-92.
7. Rogachefsky RA, Lipson SR, Applegate B, et al. Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Joint Surg (Am), 2001, 83-A(4): 509-519.
8. Lalone EA, Rajgopal V, Roth J, et al. A cohort study of one-year functional and radiographic outcomes following intra-articular distal radius fractures. Hand (N Y), 2014, 9(2): 237-243.
9. Heidari N, Clement H, Kosuge D, et al. Is sparing the pronator quadratus muscle possible in volar plating of the distal radius? J Hand Surg (Eur Vol), 2012, 37(5): 402-406.
10. Lee SK, Chaudhry S. Open reduction and internal fixation through fracture fragment specific fixation methods. Oper Tech Orthop, 2009, 19(2): 70-76.
11. 姜保國, 張殿英, 付中國, 等. 橈骨遠端骨折的治療建議. 中華創傷骨科雜志, 2010, 12(11): 1053-1056.
12. Orbay JL, Touhami A, Orbay C. Fixed angle fixation of distal radius fractures through a minimally invasive approach. Tech Hand Up Extrem Surg, 2005, 9(3): 142-148.
13. 鄧芒, 傅中國, 張殿英, 等. 橈骨遠端骨折掌側與背側接骨板固定的生物力學比較. 中華手外科雜志, 2008, 24(4): 213-216.
14. 郭雅娣, 閔捷, 李峻, 等. 單一鎖定加壓鋼板掌側入路治療橈骨遠端骨折. 中華手外科雜志, 2014, 30(3): 235-236.
15. Vosbikian MM, Ketonis C, Huang R, et al. Optimal positioning for Volar Plate Fixation of a distal radius fracture determining the distal dorsal cortical distance. Orthop Clin North Am, 2016, 47(1): 235-244.
16. Imatani J, Noda T, Morito Y, et al. Minimally invasive plate osteosynthesis for comminuted fractures of the metaphysis of the radius. J Hand Surg (Br), 2005, 30(2): 220-225.
17. Swigart CR, Badon MA, Bruegel VL, et al. Assessment of pronator quadratus repair integrity following volar plate fixation for distal radius fractures: a prospective clinical cohort study. J Hand Surg (Am), 2012, 37(9): 1868-1873.
18. Hershman SH, Immerman I, Bechtel C, et al. The effects of pronator quadratus repair on outcomes after volar plating of distal radius fractures. J Orthop Trauma, 2013, 27(3): 130-133.
19. 樊健, 蔣波, 陳凱, 等. 比較不切開與切開旋前方肌對橈骨遠端骨折掌側鋼板內固定術后療效的影響. 中華創傷骨科雜志, 2015, 17(10): 902-904.
20. Mccann PA, Amirfeyz R, Wakeley C, et al. The volar anatomy of the distal radius-an MRI study of the FCR approach. Injury, 2010, 41(10): 1012-1014.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison between minimally invasive surgery and traditional open reduction internal fixation in treatment of unstable distal radial fractures

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